of falls and of overdose, need to be considered before a particular
medication is chosen. The risk of relapse is high when medication is
discontinued, and maintenance doses may be required.14
Conclusion: Antidepressants have sound evidence of effectiveness
for use in depressed older people.
Electroconvulsive therapy
Description: Electroconvulsive therapy (ECT) involves delivering a
brief electric current to the brain to produce a cerebral seizure.
Quality of evidence: I.
Review of effectiveness: From two reviews,15,16 four RCTs were
located. The only study that compared ECT with placebo (sham
ECT) in older people17 showed that ECT was effective. ECT has
been widely used to treat severe depression in older people, and
retrospective studies have concluded that it is reasonably safe to
use, even in patients aged over 80 years.14 Possible side effects of
the treatment are memory deficit, confusion, cardiovascular problems
and an increased risk of falls. ECT requires undergoing a
general anaesthetic, with its attendant risks.
Conclusion: ECT is supported by a high level of evidence to show
that it is an effective treatment, although potential side effects
restrict its suitability mainly to people with severe depression.
Oestrogen therapy
Description: Oestrogen is usually supplied in tablet form, but is
also available in the form of a skin patch, cream, gel, injection